Basic Information
| Provider Information | |||||||||
| NPI: | 1710040621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | MARK | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | LINCOLN HOSPITAL, DEPT. OF SURGERY, RM. 6-20 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795900 | ||||||||
| FaxNumber: | 7185794620 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | LINCOLN HOSPITAL, DEPT. OF SURGERY, RM. 6-20 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795900 | ||||||||
| FaxNumber: | 7185794620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 205770 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208600000X | 205770 | NY | X | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.